tag:theconversation.com,2011:/id/topics/global-giving-38037/articlesGlobal giving – The Conversation2017-06-08T14:21:17Ztag:theconversation.com,2011:article/790602017-06-08T14:21:17Z2017-06-08T14:21:17ZEffective giving: how the world’s wealthy could help millions more people for free<figure><img src="https://images.theconversation.com/files/172952/original/file-20170608-32339-11qs6j6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">PA</span> <span class="attribution"><a class="source" href="https://www.paimages.co.uk/image-details/2.31262167">PA</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>EasyJet founder Sir Stelios Haji-Ioannou has <a href="https://www.theguardian.com/business/2017/may/30/sir-stelios-haji-ioannou-giving-pledge-half-2bn-fortune-charity">pledged</a> to give away half of his
£2 billion fortune. He was inspired by Bill Gates to join the <a href="https://givingpledge.org/About.aspx">Giving Pledge</a>, an organisation that encourages the world’s wealthiest people to publicly commit to giving at least half of their wealth to charity.</p>
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<img alt="" src="https://images.theconversation.com/files/172953/original/file-20170608-32318-1t693ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/172953/original/file-20170608-32318-1t693ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=886&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172953/original/file-20170608-32318-1t693ap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=886&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172953/original/file-20170608-32318-1t693ap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=886&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172953/original/file-20170608-32318-1t693ap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1113&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172953/original/file-20170608-32318-1t693ap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1113&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172953/original/file-20170608-32318-1t693ap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1113&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Stelios Haji-Ioannou, the brains behind easyJet, has just signed up to give half his fortune to charity.</span>
<span class="attribution"><a class="source" href="https://www.paimages.co.uk/search-results/fluid/?q=Stelios%20Haji%20Ioannou&amber_border=1&category=A,S,E&fields_0=all&fields_1=all&green_border=1&imagesonly=1&orientation=both&red_border=1&words_0=all&words_1=all#2.31302596">PA</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Founded in 2010 by Bill and Melinda Gates (Microsoft), together with Warren Buffett (Berkshire Hathaway), the Giving Pledge now has 169 signatories, including Mark Zuckerberg (Facebook), Richard Branson (Virgin), Sara Blakely (Spanx), and Elon Musk (Tesla, SpaceX). The list continues to grow.</p>
<p>No less important than whether to join the Giving Pledge is which charities to give to once you have joined. Many well-intentioned charities fail to have any positive impact, and of those that do, some have far greater positive impact than others, per dollar received. People with money to donate must choose carefully if they want their giving to be cost-effective. </p>
<p>For example, dollar for dollar, some HIV/AIDS interventions produce <a href="https://www.cgdev.org/sites/default/files/1427016_file_moral_imperative_cost_effectiveness.pdf">1,000 times the health benefit</a> that others do. And while around $100,000 could be used to help two blind people by training their guide dogs, the same amount of money could <a href="http://effective-altruism.com/ea/19w/fact_checking_comparison_between_trachoma/">prevent</a> at least 1,000 people from suffering <a href="http://www.who.int/mediacentre/factsheets/fs382/en/">trachoma-induced blindness</a>.</p>
<p>Such striking facts about the “cost-effectiveness landscape” are well-known to members of the Giving Pledge who have been keeping up with the <a href="https://www.effectivealtruism.org/articles/introduction-to-effective-altruism/">Effective Altruism</a> movement, like <a href="http://www.gatesfoundation.org/">Bill and Melinda Gates</a> or billionaire couple <a href="http://www.goodventures.org/about-us">Cari Tuna and Dustin Moskovitz</a>. Effective Altruism promotes the use of reason and evidence to work out how to help others the most with limited resources – be it time, money, or effort.</p>
<h2>Head and heart</h2>
<p>Joining the Giving Pledge does not require an individual to support any particular causes or organisations, but instead “encourages signatories to find their own unique ways to give that inspire them personally and benefit society”. Recently, New York Times’ David Brooks illustrated how fun it is to engage in <a href="https://www.nytimes.com/2017/06/06/opinion/giving-away-your-billion-warren-buffett.html">heartwarming fantasies</a> about how to use billions for good. But successful giving involves the head as well as the heart.</p>
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<img alt="" src="https://images.theconversation.com/files/172963/original/file-20170608-32312-1gmm0c1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/172963/original/file-20170608-32312-1gmm0c1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172963/original/file-20170608-32312-1gmm0c1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172963/original/file-20170608-32312-1gmm0c1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172963/original/file-20170608-32312-1gmm0c1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172963/original/file-20170608-32312-1gmm0c1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172963/original/file-20170608-32312-1gmm0c1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Melinda and Bill Gates co-created the Giving Pledge which helps feed, secure and safeguard the health of millions around the world.</span>
<span class="attribution"><a class="source" href="https://www.paimages.co.uk/image-details/2.7434933">PA</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>It is crucial that signatories take full advantage of the “opportunities to gather throughout the year to learn from experts about how best to leverage their philanthropy to address some of the world’s biggest challenges” that the Giving Pledge provides, and that they seek out the best available data and advice from independent charity evaluators such as <a href="http://www.givewell.org/about">GiveWell</a>. Failing to do this may be both irrational and wrong.</p>
<p>Consider the following analogy. A runaway train is headed towards one child trapped on the north track. There is another runaway train headed towards three children trapped on the south track. You can place your arm on the north track and stop the first train from killing one child, or you can place it on the south track and stop the other train from killing three children. Either way, you will sacrifice an arm. There is no other way to stop either train, and you cannot stop both in time. All other things are equal – for example, all four children are strangers to you.</p>
<p>Even if it’s not wrong to decline placing your arm on either track, it would be wrong to sacrifice your arm to save only one child, when you have the opportunity to save three children.</p>
<p>Similarly with charity. Even if it is not morally wrong to decline giving away half of your fortune, it would be wrong to give it to some charities when it’s clear that by giving to others you would be helping substantially more people, and at no extra cost.</p>
<h2>Bigger and better</h2>
<p>This conclusion is at odds with a fairly common assumption in the ethics of giving that, if it is permissible to keep some money for yourself, then it is also permissible to donate it to any charity you choose. In my recent <a href="http://onlinelibrary.wiley.com/doi/10.1111/papa.12065/epdf">research paper</a>, I argue this assumption is false. </p>
<p>I am not arguing that it is always clear which charities will most effectively use your money – although often it is. Nor am I arguing that it is wrong to give to causes close to your heart over more cost-effective ones that aren’t. After all, not giving to your favourite cause in favour of one that will help many more people may come at a significant personal cost to you. </p>
<p>Investigating matters of cost-effectiveness can itself be an expense to consider. But surely it is worth signatories to the Giving Pledge subtracting a very small fraction of the sum they’re pledging and putting it towards working out how they could give in the most effective way? By doing this, they could dramatically multiply their money’s positive impact at no extra cost.</p>
<p>In addition to encouraging signatories to give as effectively as they can to their favourite causes, the Giving Pledge should consider providing them with the option of adding a clause about cost-effectiveness.</p>
<p>Those signing up to such an “Effective Giving Pledge” would publicly commit to giving away half their wealth to whichever organisations they believe would “most effectively use it to improve the lives of others, now and in the years to come”.</p>
<p>If billionaires took this pledge they would simultaneously become the wealthiest individuals to take the <a href="https://www.givingwhatwecan.org/about-us/">Giving What We Can Pledge</a>, from which the clause above is quoted. An Effective Giving Pledge could supplement, rather than replace, the Giving Pledge. </p>
<p>Just as the Giving Pledge has successfully inspired many of the wealthiest people to give bigger, an Effective Giving Pledge would help inspire them to give better. </p>
<p>Helping millions of people is good, but helping billions is much better.</p><img src="https://counter.theconversation.com/content/79060/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Theron Pummer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Billionaires who pledge their fortunes to charity must not just give big, but give better. It’s all about effective altruismTheron Pummer, Director of the Centre for Ethics, Philosophy and Public Affairs, University of St AndrewsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/781712017-06-07T01:32:33Z2017-06-07T01:32:33ZHow Trump’s global health budget endangers Americans<p>Pandemics – global outbreaks of infectious diseases like the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004067/">1918 influenza</a> that killed 40 million people and the 2009 <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001558">H1N1 virus</a>, which caused up to 203,000 fatalities – are among the greatest threats the world faces. But the Trump administration wants <a href="http://kff.org/news-summary/white-house-releases-fy18-budget-request/">to cut more than US$2 billion</a> in global health funding.</p>
<p>As experts with diverse research and government experience, we argue that the U.S. must invest more in pandemic preparedness and on preventing outbreaks wherever they occur. The <a href="https://www.state.gov/documents/organization/271013.pdf">26 percent</a> reduction in these funds that President Donald Trump seeks would, we believe, devastate our already underequipped pandemic prevention and response system. In turn, that would undercut our ability to respond to future outbreaks.</p>
<p>We recommended in our recent <a href="http://bush.tamu.edu/scowcroft/white-papers/The-Growing-Threat-of-Pandemics.pdf">white paper</a> that the U.S. centralize its leadership on biodefense – that is, its response to biological threats from naturally occurring emerging and reemerging infectious diseases, accidental releases or attacks. In addition, local authorities and community leaders should do more to counter the anti-vaccine movement, and the federal government should redouble its efforts to strengthen public health institutions in developing countries.</p>
<h2>Strengthening global health</h2>
<p>The best way to protect Americans at home from infectious disease is to contain outbreaks before they get here. </p>
<p>The U.S. did that, barely, with <a href="https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html">Ebola between 2014 and 2016</a>. That outbreak caused a humanitarian disaster in West Africa and brought about a significant scare in the U.S. without ever truly endangering the American public. The few cases that did occur in the United States were contained rapidly, preventing any sort of outbreak on American soil.</p>
<p>According to former Centers for Disease Control and Prevention Director Tom Frieden, the world was merely <a href="https://www.washingtonpost.com/news/to-your-health/wp/2017/01/16/outgoing-cdc-chief-talks-about-the-agencys-successes-and-his-greatest-fear/">days away from a global catastrophe</a> when the <a href="http://www.bbc.com/news/world-africa-28755033">Ebola virus</a> was finally contained in Lagos, Nigeria. Previous <a href="http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-polio-efforts/">global health spending</a> facilitated the rapid Nigerian response.</p>
<h2>Centralizing biodefense leadership</h2>
<p>Currently, there is no unifying force that coordinates all the government departments and agencies that work together in biodefense. The U.S. needs a new national strategy to fight pandemics with centralized leadership, and the Trump administration has an opportunity to address this gap that has eluded past administrations. </p>
<p>We strongly agree with the recommendation of the 2015 <a href="http://www.biodefensestudy.org">Biodefense Blue Ribbon Panel</a> report, authored by a bipartisan group of leaders, that the vice president oversee and hold accountable almost a dozen departments with biodefense responsibilities and competing interests. The vice president is one of the only people in the White House who can coordinate across the federal government and influence state and local officials and the private sector.</p>
<p>In addition, we suggest that the <a href="https://www.usaid.gov/who-we-are/organization/bureaus/bureau-democracy-conflict-and-humanitarian-assistance/office-us">Office of Disaster Assistance</a>, an office within the U.S. Agency for International Development currently tasked with coordinating the federal response to natural and man-made disasters abroad, coordinate and lead U.S. responses to foreign pandemics. This role would be similar to the <a href="https://www.fema.gov/national-response-framework">Federal Emergency Management Agency</a> – which coordinates government, state, local, private sector and nonprofit efforts during and after domestic disasters.</p>
<h2>Countering the anti-vaccine movement</h2>
<p>The anti-vaccine movement has hindered public health campaigns ever since the English physician and scientist Edward Jenner discovered a way to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720046/">vaccinate against smallpox in 1796</a>. </p>
<p>Fueled by debunked myths connecting autism and the measles, mumps and rubella <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136032/">(MMR) vaccine</a>, the <a href="https://theconversation.com/are-us-vaccine-rates-going-down-because-public-trust-and-social-ties-are-eroding-44349">anti-vaccine movement</a> has gained traction in recent years. In some areas, such as San Juan County in Washington state, as many as <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1113008#t=article">72 percent</a> of kindergartners are not getting the vaccines doctors recommend due to noncompliance or exemptions.</p>
<p>Vaccines safeguard public health through what epidemiologists call herd immunity: Diseases don’t spread when enough people in a community get vaccinated. When everyone who can be vaccinated gets their shots, they protect not only themselves but also others who cannot get shots, such as people with medical conditions that make it impossible for them to be vaccinated. For the MMR vaccine, vaccination rates must be <a href="http://jamanetwork.com/journals/jamapediatrics/fullarticle/2203906">96-99 percent</a> to be effective. In short, parents who refuse to vaccinate their kids endanger other children as well as their own.</p>
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<a href="https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171887/original/file-20170601-25673-13son4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Amish families in Ohio were among the people who sought out measles, mumps and rubella (MMR) vaccinations in 2014 amid a big measles outbreak.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Public-Health-and-Contagions/3f098058727d4f6cb8a451f950578e03/5/0">AP Photo/Tom E. Puskar</a></span>
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<p>Consider what happened when the anti-vaccine movement <a href="http://www.cnn.com/2017/05/08/health/measles-minnesota-somali-anti-vaccine-bn/">directly targeted</a> Somali immigrants in Minnesota: Vaccination rates in that community declined from <a href="https://www.pri.org/stories/2017-05-18/minnesota-measles-outbreak-exposes-gaps-public-health">90 percent in 2008</a> to 40 percent in 2017. As a result, a measles outbreak is flaring there. Most of the 75 people <a href="http://www.health.state.mn.us/divs/idepc/diseases/measles/#Example1">diagnosed with measles</a> in the state so far are Somali-American children. This outbreak, currently concentrated in Hennepin County, illustrates why we believe states should restrict nonmedical exemptions to the childhood vaccination rules guiding public school admissions. </p>
<p>One of the things that global health aid pays for is childhood immunizations in poor countries. Widespread vaccination protects local populations from infectious diseases while reducing the chances that outbreaks will spread to the U.S. </p>
<h2>Trump’s budget</h2>
<p>Because curbing the spread of infectious diseases overseas is so important, we argue that the U.S. should spend more – not less – on global health security and basic public health in low-income countries. Many nations, like Guinea, Liberia and Sierra Leone, need facilities and supplies to prevent the spread of disease, along with trained medical personnel. The U.S. is spending roughly $8.5 billion in global health programs for everything from HIV/AIDS to Zika. Trump’s proposed budget would slash total investment in global health by about a fourth, to <a href="https://www.state.gov/documents/organization/271013.pdf">$6.5 billion</a>.</p>
<p>His budget request would also reduce the amount of money allocated for programs focused on infectious diseases like <a href="http://www.npr.org/sections/goatsandsoda/2017/05/25/529873431/trumps-proposed-budget-would-cut-2-2-billion-from-global-health-spending">HIV/AIDS, malaria and tuberculosis</a>.</p>
<p>Seemingly contradicting Trump’s spending priorities, <a href="https://www.hhs.gov/about/news/2017/05/22/secretary-price-delivers-address-at-70th-world-health-assembly.html">Health and Human Services Secretary Tom Price voiced</a> strong U.S. support for global health security at the 70th World Health Assembly in late May. “These threats do not respect borders between countries, and can spread rapidly to endanger people anywhere around the globe,” he said.</p>
<p>To be sure, Trump’s proposed budget, does call for a new, emergency response fund <a href="https://insidehealthpolicy.com/daily-news/trump-calls-new-public-health-emergency-response-fund">to battle disease outbreaks</a>. While necessary, that innovation would not bridge the gap created by the lack of a national biodefense strategy. </p>
<p>And at least some lawmakers champion global health aid, suggesting that Congress may reject Trump’s proposed cuts. International health agencies “are the front lines of defense for the American people for some pretty awful things,” said <a href="https://www.washingtonpost.com/national/health-science/the-trump-administration-is-ill-prepared-for-a-global-pandemic/2017/04/08/59605bc6-1a49-11e7-9887-1a5314b56a08_story.html?utm_term=.15099cb39ae9">Representative Tom Cole</a>, an Oklahoma Republican. “If the idea of a government is to protect the United States and its people, then these people contribute as much as another wing on an F-35 (fighter jet), and actually do more to save tens of thousands of lives.”</p>
<p>Shortchanging efforts to prevent pandemics will increase their threat worldwide. It will also make Americans less safe no matter where those outbreaks start.</p><img src="https://counter.theconversation.com/content/78171/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Natsios sits on the board of directors (and own shares) of a company (FIO Corporation) which makes an infectious disease diagnostic device which was used, with Gates Foundation funding, to track the spread of the Ebola Pandemic West Africa. </span></em></p><p class="fine-print"><em><span>Christine Crudo Blackburn and Gerald W Parker do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Trump wants to slash global health funding at a time when more investment is needed, not less. This spending can protect Americans – as well as foreigners – from deadly diseases.Gerald W Parker, Director, Pandemic and Biosecurity Policy Program, Scowcroft Institute for International Affairs, Bush School of Government and Public Service, and Associate Dean for Global One Health, College of Veterinary Medicine, Texas A&M UniversityAndrew Natsios, Director, Scowcroft Institute of International Affairs and Executive Professor, Texas A&M UniversityChristine Crudo Blackburn, Postdoctoral Research Fellow, Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/778382017-05-19T01:00:45Z2017-05-19T01:00:45ZTrump’s global gag order: 5 questions answered<figure><img src="https://images.theconversation.com/files/169611/original/file-20170516-11920-18ugjes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Community health workers like these visit patients’ homes in Malawi to help prevent mother-to-child transmission of HIV. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/usaid_images/14929179975/in/photolist-fpbMUp-aQMAYZ-dCxeUD-aSur7V-b3R1Rt-b3R2oX-dEVMyy-b3R27a-dRQPAZ-6ZtchW-hgsjEG-5bwcvw-9Ew4ZB-9Ui5Dt-dAYLds-oKeX3F-dU2Dh3-qFoYn-dw9Hnp-dEBboS-fgvYov-aQMAZ6-bEyXDR-aMxvhD-fgLeJY-qbViAL-cni9zU-hHrpg9-hHqXKb-c2XNWA-aRwNcx-oERaPx-u7rF96-hHrKFM-945Zp6-fokQm2-oFmDXh-9W2YA2-4v8yRi-cE9xzJ-oKeX5K-fEQHxX-9VxEus-hHqCbR-dw9fng-cE9bkd-bmCsUq-9VuPrz-dEQncT-kXqimY/">Baylor College of Medicine Children's Foundation–Malawi/Chris Cox</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p><em>Editor’s note: President Donald Trump recently signed an executive order that media reports say could obstruct nearly US$8.8 billion the U.S. spends annually to <a href="http://khn.org/morning-breakout/trumps-abortion-gag-rule-will-block-8-8b-in-aid-to-fight-malaria-aids-and-other-diseases/">fight deadly diseases abroad</a>. Here, Maureen Miller, a Columbia University Medical Center professor and infectious disease epidemiologist with training in medical anthropology, answers five questions about this move, including what it has to do with abortion.</em></p>
<h2>1. What’s at stake?</h2>
<p>Three of the biggest killers in the developing world are AIDS, tuberculosis and malaria. Currently 36.7 million people are <a href="http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf">living with HIV/AIDS</a>, a third of the world’s population is <a href="https://www.cdc.gov/tb/statistics/">infected with tuberculosis</a> and more than one million people <a href="https://www.unicef.org/health/files/health_africamalaria.pdf">die from malaria</a> each year.</p>
<p>Trump’s executive order endangers $6.8 billion in annual funding for the <a href="https://www.pepfar.gov/funding/budget/index.htm">President’s Emergency Plan for AIDS Relief</a>. Former President George W. Bush created this initiative, known as PEPFAR, to help save the lives of people suffering from HIV/AIDS. </p>
<p>The U.S. put <a href="http://kff.org/global-health-policy/fact-sheet/u-s-federal-funding-for-hivaids-trends-over-time/">$1.35 billion</a> of that money into the the Global Fund to Fight AIDS, Tuberculosis and Malaria last year. This independent organization is the largest entity dedicated to preventing and treating these diseases. The U.S., its top donor, covers half <a href="http://kff.org/global-health-policy/fact-sheet/the-u-s-the-global-fund-to-fight-aids-tuberculosis-and-malaria/">the Global Fund’s operating costs</a>, but that represents only a quarter of what our nation spends to fight these diseases internationally. Some $600 million in family planning aid is affected, as is <a href="https://theconversation.com/will-trumps-global-family-planning-cuts-cause-side-effects-75813">other spending</a> slated for global health. </p>
<p>Although I follow these issues closely, I have been unable to find a complete breakdown of the widely reported <a href="http://khn.org/morning-breakout/trumps-abortion-gag-rule-will-block-8-8b-in-aid-to-fight-malaria-aids-and-other-diseases/">$8.8 billion affected</a>.</p>
<p>Women compose <a href="http://Aidsinfo.unaids.org">51 percent of the people living with HIV/AIDS</a> worldwide. Since 60 percent of the people with the virus in sub-Saharan Africa are women, they may bear the brunt of this move. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/169610/original/file-20170516-11945-en0mnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/169610/original/file-20170516-11945-en0mnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169610/original/file-20170516-11945-en0mnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169610/original/file-20170516-11945-en0mnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169610/original/file-20170516-11945-en0mnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169610/original/file-20170516-11945-en0mnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169610/original/file-20170516-11945-en0mnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eunice Adhiambo, an HIV-positive Kenyan woman, and her HIV-negative daughter Jyll.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/usaidafrica/9451379699/in/photolist-fpbMUp-aQMAYZ-dCxeUD-aSur7V-b3R1Rt-b3R2oX-dEVMyy-b3R27a-dRQPAZ-6ZtchW-hgsjEG-5bwcvw-9Ew4ZB-9Ui5Dt-dAYLds-oKeX3F-dU2Dh3-qFoYn-dw9Hnp-dEBboS-fgvYov-aQMAZ6-bEyXDR-aMxvhD-fgLeJY-qbViAL-cni9zU-hHrpg9-hHqXKb-c2XNWA-aRwNcx-oERaPx-u7rF96-hHrKFM-945Zp6-fokQm2-oFmDXh-9W2YA2-4v8yRi-cE9xzJ-oKeX5K-fEQHxX-9VxEus-hHqCbR-dw9fng-cE9bkd-bmCsUq-9VuPrz-dEQncT-kXqimY">Riccardo Gangale/USAID Kenya</a></span>
</figcaption>
</figure>
<h2>2. How does the US support global efforts to fight and treat HIV/AIDS?</h2>
<p>PEPFAR, primarily implemented through USAID, the National Institutes of Health and the Centers for Disease Control and Prevention, emphasizes improving the health of women, newborns and children. Among its biggest achievements has been integrating AIDS relief and reproductive health services, since HIV is transmitted primarily through unprotected sex. </p>
<p>Until now, PEPFAR has commanded broad bipartisan support, perhaps due to its well-documented success. For the first time since the HIV/AIDS epidemic began in the 1980s, new HIV infections in sub-Saharan Africa – which accounts for <a href="http://aidsinfo.unaids.org/">almost two-thirds</a> of all people living with HIV/AIDS – <a href="http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf">are decreasing</a>. Former President Bush, who <a href="http://www.reuters.com/article/us-africa-bush-idUSKBN1761LJ">traveled to Botswana and Namibia</a> in April, still champions the program.</p>
<h2>3. How is global health aid connected to abortion?</h2>
<p>An estimated <a href="http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-international-family-planning-reproductive-health-efforts/">303,000 women</a>, primarily in developing countries, die yearly from complications due to pregnancy, childbirth and abortion, and those are the <a href="http://www.who.int/mediacentre/news/releases/2017/yearly-adolescent-deaths/en/">leading causes of death</a> among adolescent girls globally. Approximately one-third of maternal deaths could be prevented if all women had access to effective contraception.</p>
<p>The U.S. is the <a href="http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-international-family-planning-reproductive-health-efforts/">world’s largest supporter</a> of family planning and reproductive health services. It is also one of the largest purchasers and distributors of contraceptives. <a href="http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-international-family-planning-reproductive-health-efforts/">No federal funds have paid for abortions</a>, however, since 1973 – either internationally or at home. All nongovernmental organizations receiving U.S. support must agree to this policy.</p>
<p>In 1984, the Reagan administration expanded those restrictions by denying U.S. family-planning money to entities that performed abortions or promoted the practice. Subsequent Democratic presidents lifted this restriction, known either as the “<a href="http://kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/">Mexico City policy</a>” or the “global gag rule,” while Republican presidents reinstated it.</p>
<p>Trump framed his new order as “<a href="https://www.state.gov/r/pa/prs/ps/2017/05/270866.htm">Protecting Life in Global Health Assistance</a>,” but it’s unlikely to reduce the number of abortions performed in poor countries. A <a href="http://www.who.int/bulletin/volumes/89/12/11-091660/en/">2011 study by Stanford University researchers</a> found that abortion rates in sub-Saharan African countries rose when the standard restrictions were in force from 2001 to 2008. </p>
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<h2>4. How does Trump’s action stray from Republican precedents?</h2>
<p>The Trump administration has expanded the policy’s reach, broadening it to encompass all foreign health care providers that receive U.S. funding rather than only those that get family planning dollars. For example, any group that does sexual health education to prevent the spread of HIV and also informs women that abortion is legal where they live will <a href="https://www.statnews.com/2017/05/16/mexico-city-policy-global-health-funding/">lose their U.S. support</a>. They would have remained eligible for that money had Trump followed the pattern set by the past three Republican administrations.</p>
<p>The exact repercussions are unknown. The <a href="https://www.state.gov/r/pa/prs/ps/2017/05/270879.htm">State Department</a>, under Rex Tillerson’s leadership, plans to review the impact within six months.</p>
<h2>5. Can other donors bridge the gaps?</h2>
<p>It’s unclear which organizations will agree to these new restrictive terms or what will happen to spending. The administration says it <a href="https://www.state.gov/r/pa/prs/ps/2017/05/270879.htm">will redistribute funds</a> from organizations that refuse to comply to those that will. </p>
<p>But those other groups may not exist. As Johnathan Rucks of the <a href="https://www.nytimes.com/2017/05/15/us/politics/trump-gag-rule-abortion.html?rref=collection%2Fbyline%2Fgardiner-harris&action=click&contentCollection=undefined&region=stream&module=stream_unit&version=latest&contentPlacement=2&pgtype=collection">global health group PAI</a> told The New York Times: “It’s not like we have an influx of providers in places like West Africa.” </p>
<p>Given the limited alternatives, the number of unmet health needs will surely rise, particularly for women and children. In March, other governments and private funders announced they had raised <a href="http://www.npr.org/sections/goatsandsoda/2017/03/02/517959453/-190-million-raised-to-fill-aid-gap-left-by-trumps-abortion-rule">$190 million for international family planning</a> to narrow the anticipated gap caused by the Trump administration’s policies. Now, that’s probably just a drop in the bucket of what will be needed.</p>
<p><a href="https://www.theguardian.com/global-development/2017/feb/14/bill-and-melinda-gates-trumps-global-gag-rule-endangers-millions-women-girls-us-funding">Bill Gates</a>, a philanthropist who with his wife Melinda gives more than <a href="http://www.gatesfoundation.org/Who-We-Are/General-Information/Foundation-Factsheet">$4 billion</a> away every year, mostly to improve global health and fight poverty, told The Guardian that Trump’s expansion of the policy could “create a void that even a foundation like ours can’t fill.”</p><img src="https://counter.theconversation.com/content/77838/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maureen Miller does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>All recent Republican presidents have cut off foreign aid tied to abortion. Trump’s expansive version of those restrictions endangers billions slated for HIV/AIDS, malaria and other diseases.Maureen Miller, Adjunct Associate Professor of Epidemiology, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/753682017-05-04T02:06:35Z2017-05-04T02:06:35ZAnti-terror rules are blocking aid to conflict zones<figure><img src="https://images.theconversation.com/files/166712/original/file-20170425-13383-18v7rpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rules imposed after the 9/11 attacks can obstruct aid to Somalia's internally displaced people.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/au_unistphotostream/33342126475/in/photolist-SNk7zz-TaUXFp-RFGagb-FF65gc-QCKb7m-N3u95N-M8VZ8T-MVoeBu-N6zNEe-MVoexm-M8QEnC-HDgJLX-FftNZA-FKPij5-G2LjrN-FftKjj-G2LgW7-G55eTR-FKPdio-FftGA3-G2Lc7N-FfEmXH-G556er-G2LdBw-F8ANwr-GaVehM-G8CFzo-GaVvCH-G553ZB-FfEg3B-FfEhaX-FfEi4k-G54XZM-FKP1Cj-FKNWwU-FfE9wv-GaViWM-FKNR7f-FftmXq-FftiwC-FfthFu-GaV88H-FfE1cz-G8CeKs-G8ChBQ-Fft8b7-G54C8T-FKNFGd-G2KHkW-FfuYTm">Omar Abdisalan/AMISOM Photo </a></span></figcaption></figure><p>The famines looming in countries like war-torn Yemen and Somalia and the conflicts entrenched in Syria, Iraq and elsewhere are making it hard for aid workers to reach everyone who desperately needs help. However, U.S. restrictions on humanitarian aid and the funds immigrants send their relatives back home – intended to starve terrorists of cash – are <a href="https://www.theguardian.com/sustainable-business/somalia-remittances-financial-institution-operate-conflict-zone">getting in the way</a>. </p>
<p>These rules treat all money transferred to foreign nonprofit groups as being illegitimate, or at least suspect, unless proven otherwise. Research suggests that these measures, enforced by the Treasury Department, go beyond their stated purpose of preventing terrorist attacks. The regulations also endanger individual donors.</p>
<p>As a scholar who has studied philanthropy, both in the U.S. and around the world, I believe it’s time to consider lifting or loosening some of these restrictions in light of ongoing crises and signs that they are blocking legitimate aid.</p>
<h2>Casualties rising</h2>
<p>There are 6.3 million Syrians displaced internally, and about <a href="http://www.unocha.org/syria">5 million Syrian refugees</a> have fled to find safer homes. According to U.N. estimates, the conflict and its collateral damage have killed <a href="http://www.unmultimedia.org/radio/english/2016/04/syria-envoy-claims-400000-have-died-in-syria-conflict/#.WOot1tLyuUm">more than 400,000 Syrians</a>.</p>
<p>The need for assistance, in cash and in kind, is as staggering as the casualties. The International Committee of the Red Cross is <a href="https://www.nytimes.com/2017/03/22/world/africa/famine-yemen-somalia-red-cross-relief.html?_r=0">short US$300 million</a> to meet its goals in Yemen. <a href="http://www.reuters.com/article/us-yemen-security-toll-idUSKCN11516W">That conflict</a> has displaced over 3 million people, many of whom are at risk of starvation. About 10,000 people have died there, another 40,000 have been injured and some 14 million Yemenis – out of a population of 26 million – need food aid, according to the United Nations. </p>
<p>All told, <a href="http://www.cnn.com/2017/03/11/africa/un-famine-starvation-aid/">20 million people</a> could die from starvation and related diseases in the coming months just in Yemen, Somalia, Nigeria and South Sudan. “We are facing the largest humanitarian crisis since the creation of the U.N.” after World War II, U.N. Emergency Relief Coordinator <a href="http://www.un.org/apps/news/story.asp?NewsID=56339#.WQd_NNLyuUl">Stephen O’Brien</a> said in March.</p>
<h2>Post-9/11 legacy</h2>
<p>Whenever extremists tried to control access to aid in the past, delivering it was hard. Fallout from the 9/11 terrorist attacks made the task even harder.</p>
<p>Specifically, President George W. Bush issued an <a href="https://www.state.gov/j/ct/rls/other/des/122570.htm">executive order</a> to prevent suspected terrorists from profiting off of charities used as fronts. Soon after, the Treasury Department <a href="http://www.nytimes.com/2008/11/25/us/25charity.html">shut down</a> three of the largest U.S.-based Muslim-led charities: Holy Land Foundation, Global Relief Foundation and Benevolence International Foundation for providing material support to terrorist organizations in the Middle East. Bush sought to crack down on any sources that could have supported terrorism in the U.S. and abroad and this was the (politically) expedient thing to do at that time. </p>
<p>The government froze <a href="https://www.treasury.gov/resource-center/sanctions/Programs/Documents/tar2014.pdf">over $20 million</a> in assets belonging to the three nonprofits. Subsequent investigations and analysis by the American Civil Liberties Union (ACLU) and others have pointed to the fact that many of the measures the U.S. government used against these nonprofits were unconstitutional because they did not allow for due process, as <a href="https://www.aclu.org/files/pdfs/humanrights/blockingfaith.pdf">mandated by law</a>.</p>
<p>Sometimes this lack of due process ensnares American donors. Consider the case of <a href="http://www.nytimes.com/2003/02/27/nyregion/4-accused-of-illegally-sending-money-to-iraq.html">Dr. Rafil Dhafir</a>, a U.S. citizen. The Iraqi-born oncologist from Syracuse, New York, was convicted of sending money to Iraq illegally through his charity, Help The Needy, although the government brought no terrorism charges against him. The fact that he sent money to a country against which the U.S. had sanctions at the time was enough for the court to sentence him. He remains behind bars <a href="http://www.dhafirtrial.net/2017/02/26/dr-dhafir-14th-anniversary/#more-10086">14 years later</a>, serving a 22-year sentence that symbolizes the risks posed by giving while Muslim in the United States.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/166819/original/file-20170426-2855-vm0uew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/166819/original/file-20170426-2855-vm0uew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166819/original/file-20170426-2855-vm0uew.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166819/original/file-20170426-2855-vm0uew.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166819/original/file-20170426-2855-vm0uew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166819/original/file-20170426-2855-vm0uew.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166819/original/file-20170426-2855-vm0uew.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Supporters of Dr. Rafil Dhafir, an Iraqi-American incarcerated for sending money to Iraq before the Iraq War.</span>
<span class="attribution"><a class="source" href="http://www.dhafirtrial.net/photo-page-5/">Katherine Hughes</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The Bush-era restrictions continue to boost oversight and fuel an atmosphere of suspicion around nongovernmental aid to the Middle East and North Africa. Meanwhile, many nonprofits that deliver aid to conflict zones face undue hassles. Banks may refuse to wire money, charging a higher fee or asking for onerous paper work. The Charity and Security Network, a group that advocates on behalf of international nongovernmental organizations, <a href="http://www.charityandsecurity.org/system/files/FinancialAccessFullReport_2.21%20%282%29.pdf">parsed data</a> from over 1,010 nonprofits. It found that these delays lead to schools not being staffed, salaries not being paid and refugees not getting the services they need. </p>
<p>The sanctions against countries like those in place in <a href="https://www.treasury.gov/resource-center/sanctions/Programs/pages/syria.aspx">Syria</a> and <a href="https://www.treasury.gov/resource-center/sanctions/Programs/Documents/yemen.pdf">Yemen</a>, which bar any form of “service” by U.S. citizens, also prohibit most organizations from dealing with banks and other financial institutions in these countries. </p>
<h2>Remittances</h2>
<p>Beyond targeting charity, the terrorism restrictions threaten another key source of aid for the victims of famine and war: remittances. <a href="https://www.vox.com/2016/4/8/11385842/remittances-immigrants-mexico">Immigrants send money</a> to their relatives, friends and others who reach out to them. Giving based on religious and ethnic identity is common. Muslim giving across borders is hard to measure but ranges between <a href="http://www.irinnews.org/report/95564/analysis-faith-based-aid-revolution-muslim-world">$200 billion and $1 trillion</a>, according to IRIN, a United Nations news service.</p>
<p>Somalia, for instance, gets about $1.3 billion – more than a fifth of its gross domestic product – from <a href="http://www.worldbank.org/en/country/somalia/overview">remittances</a>, according to the World Bank.</p>
<p>As <a href="https://www.theguardian.com/global-development/2015/feb/06/somali-us-money-transfers-merchants-bank-remittances">journalists have reported</a>, scrutiny over remittances to Somalia have led several U.S. banks to shut down their remittance divisions. It has also made illegal and quasi-legal systems that sidestep <a href="https://www.gdrc.org/icm/hawala.html">official banking networks</a> more common. This can make oversight even more elusive and wreak devastating consequences on the day-to-day lives of millions of Somalis, who depend on these funds for their livelihood. </p>
<p>As the Charity and Security Network explained in its <a href="http://www.charityandsecurity.org/FinAccessReport">Financial Access for U.S. Nonprofits</a> report, nonprofits working in conflict zones have terminated projects or opted to not provide aid, simply to avoid the appearance of violating some regulatory norm. The report argues that many rules intended to fight money laundering and terrorism financing have stymied efforts by nonprofits to provide lifesaving assistance in Somalia, Syria and other conflict zones. </p>
<p>Further, as the American Civil Liberties Union said in its “<a href="https://www.aclu.org/files/pdfs/humanrights/blockingfaith.pdf">Blocking Faith, Freezing Charity</a>” report, one problem is that these charities have little recourse to appeal decisions when the U.S. government deems them to be tied to terrorists. There is no oversight mechanism in place as the Treasury Department exercises its authority to determine whether aid groups are helping terrorists or are influenced by extremists. These determinations cannot be appealed.</p>
<p>If U.S. regulations obstruct assistance out of unfounded fears, it may harm noncombatants and civilians caught in the crossfire. The Trump administration should revisit those rules to ensure that Americans who want to help – through <a href="https://theconversation.com/can-blockchain-technology-help-poor-people-around-the-world-76059">philanthropy and remittances</a> – may exercise their freedom to be generous toward people experiencing multiple emergencies at once.</p>
<p>In countries like Syria and Somalia, it could mean the difference between life and death.</p><img src="https://counter.theconversation.com/content/75368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sabith Khan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rules imposed after 9/11 and still on the books are getting in the way of delivering aid to conflict zones. In countries like Yemen and Syria, it could mean the difference between life and death.Sabith Khan, Visiting Researcher, Georgetown UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/760592017-05-01T01:57:44Z2017-05-01T01:57:44ZCan blockchain technology help poor people around the world?<figure><img src="https://images.theconversation.com/files/167209/original/file-20170428-12970-fr3av3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No need for a bank: Just a smartphone and a blockchain. </span> <span class="attribution"><a class="source" href="https://insight.wfp.org/what-is-blockchain-and-how-is-it-connected-to-fighting-hunger-7f1b42da9fe">Houman Haddad/UN World Food Program</a></span></figcaption></figure><p>Big Wall Street companies are using a complicated technology called blockchain to further <a href="https://www.wsj.com/articles/wall-street-backs-blockchain-for-savings-on-derivatives-1483979438">increase the already lightning-fast speed of international finance</a>. But it’s not just the upper crust of high finance who can benefit from this new technology.</p>
<p>Most simply, a blockchain is an inexpensive and transparent way to record transactions. People who don’t know each other – and therefore may not trust each other – can securely exchange money without fear of fraud or theft. Major aid agencies, nonprofits and startup companies are <a href="https://www.technologyreview.com/s/604144/how-blockchain-can-lift-up-the-worlds-poor/">working to extend blockchain systems across the developing world</a> to help poor people around the world get easier access to banks for loans or to protect their savings.</p>
<p>In my work as a scholar of business and technology focusing on the impact of <a href="http://dx.doi.org/10.1080/01436597.2017.1298438">blockchain</a> and other modern technologies such as <a href="http://dx.doi.org/10.1080/01436597.2011.586225">cloud computing</a>, <a href="https://doi.org/10.1177/2053951714564227">big data</a> and <a href="http://dx.doi.org/10.1080/01436597.2016.1191942">the Internet of Things</a> on poor people, I see four main ways blockchain systems are already beginning to connect some of the world’s poorest people with the global economy.</p>
<h2>How does a blockchain work?</h2>
<p>A blockchain is a fancy word for a transaction-recording computer database that’s stored in lots of different places at once. The best-known example of <a href="http://www.lexology.com/library/detail.aspx?g=cf0c71c5-055a-4d57-92f8-c75d1e282414">blockchain technology</a> is the electronic cryptocurrency called bitcoin, but the concept can be <a href="https://theconversation.com/blockchains-focusing-on-bitcoin-misses-the-real-revolution-digital-trust-58125">applied in lots of different ways</a>.</p>
<p>One way to think about a blockchain is as a public bulletin board to which anyone can post a transaction record. Those posts have to be digitally signed in a particular way, and once posted, a record can never be changed or deleted. The data are stored on many different computers around the internet, and even around the world.</p>
<p>Together, these features – openness to writing and inspection, authentication through computerized cryptography and redundant storage – provide a mechanism for secure exchange of funds. They can even involve what are called “<a href="https://theconversation.com/blockchains-focusing-on-bitcoin-misses-the-real-revolution-in-digital-trust-58125">smart contracts</a>,” transactions that happen only if certain conditions are met – such as a life insurance policy that sends money to the beneficiary only if a specific doctor submits a digitally signed death certificate to the blockchain.</p>
<p>Right now, these sorts of services are available – even in the developed world – only because nations have strong regulations protecting the money people deposit in banks, and clear laws about obeying the terms of formal contracts. In the developing world, these rules often don’t exist at all – so the services that depend on them don’t either, or are so expensive that most people can’t use them. For instance, to open a checking account in some parts of Africa, <a href="http://siteresources.worldbank.org/DEC/Resources/Banking_Services_for_Everyone.pdf">banks require enormous minimum deposits</a>, sometimes more money than an average person earns in a year.</p>
<p>A blockchain system, though, inherently enforces rules about authentication and transaction security. That makes it safe and affordable for a person to store any amount of money securely and confidently. While that’s still in the future, blockchain-based systems are already helping people in the developing world in very real ways.</p>
<h2>Sending money internationally</h2>
<p>In 2016, emigrants working abroad sent an <a href="http://www.worldbank.org/en/news/press-release/2016/10/06/remittances-to-developing-countries-expected-to-grow-at-weak-pace-in-2016-and-beyond">estimated US$442 billion</a> to their families in their home countries. This global flow of cash is a <a href="http://www.imf.org/external/pubs/ft/fandd/2005/12/basics.htm">significant factor in the financial well-being</a> of families and societies in developing nations. But the process of sending money can be extremely expensive. </p>
<p>Using MoneyGram, for example, a worker in the U.S. with US$50 to send to Ghana <a href="https://www.newsghana.com.gh/report-puts-ghana-amongst-countries-with-high-cost-of-remittance/">might have to pay $10 in fees</a>, meaning her family would receive only $40. <a href="http://www.worldbank.org/en/topic/paymentsystemsremittances/publication/cost-sending-remittances-june-2015-data">In 2015, transaction costs and commission rates averaged</a> 10.96 percent for remittances sent from banks and 6.36 percent for sending money through money transfer operators. Companies justify their costs by saying they reflect the price of <a href="http://allafrica.com/stories/201703010933.html">providing reliable and convenient services</a>.</p>
<p>By contrast, Hong Kong’s blockchain-enabled Bitspark has transaction costs so low it <a href="http://www.scmp.com/lifestyle/technology/article/1679904/bitcoin-transactions-cut-cost-international-money-transfers">charges a flat HK$15 for remittances of less than HK$1,200</a> (about $2 in U.S. currency for transactions less than $150) and 1 percent for larger amounts. Using the secure digital connections of a blockchain system lets the company <a href="https://news.bitcoin.com/bitspark-bitcoin-remittance-asia/">bypass existing banking networks and traditional remittance systems</a>.</p>
<p>Similar services helping people send money to the Philippines, Ghana, Zimbabwe, Uganda, Sierra Leone and Rwanda <a href="https://bitcoinmagazine.com/articles/african-bitcoin-startup-wins-bill-melinda-gates-foundation-grant-launches-blockchain-event-series-nairobi-1436993383">also charge a fraction of the current banking rates</a>.</p>
<h2>Insurance</h2>
<p>Most people in the developing world lack health and life insurance, primarily because it’s so expensive compared to income. Some of that is because of high administrative costs: <a href="http://dx.doi.org/10.1002/jid.3380040602">For every dollar of insurance premium collected</a>, administrative costs amounted to $0.28 in Brazil, $0.54 in Costa Rica, $0.47 in Mexico and $1.80 in the Philippines. And many people who live on less than a dollar a day have neither the ability to afford any insurance, nor any company offering them services.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167206/original/file-20170428-13007-zo33ik.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Smartphones are increasingly common in the developing world.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dfid/7561270846">Russell Watkins/UK Department for International Development</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>In India, for example, <a href="http://www.tribuneindia.com/news/business/health-insurance-roadmap-for-2015/42439.html">only 15 percent of the population has health insurance</a>. Even those people <a href="http://www.ajmc.com/journals/issue/2011/2011-2-vol17-n2/ajmc_11feb_thomaswebx_e26to33">pay higher relative premiums</a> than in developed countries. As a result, people in South Asia pay a <a href="https://www.brookings.edu/wp-content/uploads/2016/07/theimpactofhealthinsurance_fulltext.pdf">much greater share of their health care costs</a> out of their own pockets than do people in high-income industrialized countries.</p>
<p>Because blockchain systems are online and involve verification of transactions, they can <a href="http://dx.doi.org/10.1080/01436597.2016.1191942">deter (and expose) fraud</a>, dramatically cutting costs for insurers.</p>
<p>Consuelo is a <a href="https://cointelegraph.com/news/consuelo-offers-blockchain-powered-microinsurance-to-migrant-workers">blockchain-based microinsurance service</a> backed by Mexican mobile payments company Saldo.mx. Customers can pay small amounts for health and life insurance, with claims verified electronically and paid quickly.</p>
<h2>Helping small businesses</h2>
<p>Blockchain systems can also help very small businesses, which are often short of cash and also find it expensive – if not impossible – to borrow money. For instance, after delivering medicine to hospitals, <a href="http://www.coindesk.com/ibm-amps-china-blockchain-new-supply-chain/">small drug retailers in China often wait up to 90 days to get paid</a>. But to stay afloat, these companies need cash. They rely on intermediaries that pay immediately, but don’t pay in full. A $100 invoice to a hospital might be worth $90 right away – and the intermediary would collect the $100 when it was finally paid.</p>
<p>Banks aren’t willing to lend money in places where <a href="http://www.livemint.com/Companies/vkpTgJ1M39TbRHvG1nZGsK/Reebok-India-fake-sales-and-secret-depots.html">fraudulent invoices are common</a>, or where manufacturers and their customers might have <a href="https://www.cryptocoinsnews.com/ibm-mahindra-develop-blockchain-supply-chain-finance-solutions-india/">inconsistent and error-ridden records</a>. A blockchain system reduces those concerns because these records must be authenticated before being added to the books, and because they can’t be changed.</p>
<p>Those Chinese pharmaceutical companies are <a href="http://www.coindesk.com/ibm-amps-china-blockchain-new-supply-chain/">getting help from Yijan</a>, a blockchain that is a joint effort of IBM and Chinese supply management company Hejia. Electronics, auto manufacturing and clothing companies facing similar difficulties are the <a href="https://www.cryptocoinsnews.com/chinese-fintech-firms-launch-blockchain-supply-chain-finance-platform/">test markets for Chained Finance</a>, a blockchain platform backed by financial services company Dianrong and FnConn, the Chinese subsidiary of Foxconn.</p>
<h2>Humanitarian aid</h2>
<p>Blockchain technology can also improve humanitarian assistance. <a href="https://oig.usaid.gov/sites/default/files/audit-reports/4-674-11-004-p.pdf">Fraud, corruption</a>, <a href="http://dx.doi.org/10.1002/tie.20404">discrimination</a> and <a href="https://oig.usaid.gov/sites/default/files/audit-reports/1-524-09-002-p.pdf">mismanagement</a> block some money intended to reduce poverty and improve education and health care from actually helping people.</p>
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<img alt="" src="https://images.theconversation.com/files/167208/original/file-20170428-12979-82psfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167208/original/file-20170428-12979-82psfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=210&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167208/original/file-20170428-12979-82psfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=210&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167208/original/file-20170428-12979-82psfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=210&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167208/original/file-20170428-12979-82psfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=264&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167208/original/file-20170428-12979-82psfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=264&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167208/original/file-20170428-12979-82psfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=264&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A pilot project in Pakistan is using a blockchain system to help needy families get cash and food.</span>
<span class="attribution"><a class="source" href="http://innovation.wfp.org/blog/blockchain-crypto-assistance-wfp">Farman Ali/UN World Food Program</a></span>
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<p>In early 2017 the U.N. World Food Program launched the first stage of what it calls “<a href="http://innovation.wfp.org/blog/blockchain-crypto-assistance-wfp">Building Block</a>,” giving food and cash assistance to needy families in Pakistan’s Sindh province. An internet-connected smartphone authenticated and recorded payments from the U.N. agency to food vendors, ensuring the recipients got help, the merchants got paid and the agency didn’t lose track of its money.</p>
<p>The agency expects using a blockchain system will reduce its overhead costs <a href="http://innovation.wfp.org/project/building-blocks">from 3.5 percent to less than 1 percent</a>. And it can <a href="https://insight.wfp.org/what-is-blockchain-and-how-is-it-connected-to-fighting-hunger-7f1b42da9fe">speed aid to remote or disaster-struck areas</a>, where ATMs may not exist or banks are not functioning normally. In urgent situations, blockchain currency can even take the place of scarce local cash, allowing aid organizations, residents and merchants to exchange money electronically.</p>
<p>Blockchains can even help individuals contribute to aid efforts overseas. Usizo is a South Africa-based blockchain platform that <a href="http://disrupt-africa.com/2015/11/5-african-crowdfunding-startups-to-watch/">lets anyone help pay electricity bills for community schools</a>. Donors can track how much electricity a school is using, calculate how much power their donation will buy and transfer the credit directly using bitcoin.</p>
<h2>Future potential</h2>
<p>In the future, blockchain-based projects can help people and governments in other ways, too. As many as 1.5 billion people – 20 percent of the world’s population – <a href="http://www.worldbank.org/en/programs/id4d">don’t have any documents that can verify their identity</a>. That limits their ability to use banks, but also can bar their way when trying to access basic human rights like voting, getting health care, going to school and traveling.</p>
<p>Several companies are launching <a href="https://hbr.org/2017/03/blockchain-will-help-us-prove-our-identities-in-a-digital-world">blockchain-powered digital identity programs</a> that can help create and validate individuals’ identities. Using only an internet-connected smartphone, a person is photographed and recorded on video making particular facial expressions and speaking, reading an on-screen text. The data are recorded on a blockchain and can be accessed later by anyone who needs to check that person’s identity. </p>
<p>Without email, phones, passports or even birth certificates, a blockchain could be the only way many poor people have to prove who they are. That could really make their lives better and expand their opportunities.</p><img src="https://counter.theconversation.com/content/76059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nir Kshetri does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Already becoming a darling of Wall Street, blockchain technology’s biggest real benefits could come to the world’s poorest people. Here’s how.Nir Kshetri, Professor of Management, University of North Carolina – GreensboroLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/758132017-04-17T22:57:35Z2017-04-17T22:57:35ZWill Trump’s global family planning cuts cause side effects?<figure><img src="https://images.theconversation.com/files/165138/original/image-20170412-25875-nkcuv9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Actress and U.N. Population Fund Goodwill Ambassador Ashley Judd visited a refugee camp in Mafraq, Jordan in 2016. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Mideast-Jordan/693454dd4a3841a5bc0b031a443fa2e8/3/0">AP Photo/Raad Adayleh</a></span></figcaption></figure><p>President Donald Trump is leading an assault on family planning around the world.</p>
<p>Most recently, his administration <a href="https://www.devex.com/news/trump-administration-cuts-all-future-us-funding-to-unfpa-89986">cut off U.S. contributions</a> to the <a href="http://www.unfpa.org/">United Nations Population Fund</a>, which provides and funds reproductive health services in poor countries. That follows his reinstatement of what’s known as the “<a href="https://theconversation.com/trumps-global-gag-rule-will-cause-more-abortions-not-fewer-71881">global gag rule</a>,” the executive order enacted by all Republican presidents since Ronald Reagan barring foreign <a href="https://theconversation.com/us-foreign-aid-explained-74810">nongovernmental organizations (NGOs)</a> that receive U.S. funding from even mentioning abortion. </p>
<p>But Trump wants to go even further than his GOP predecessors by slashing spending on global health efforts funded through the <a href="https://www.usaid.gov/">United States Agency for International Development</a> (USAID). Deeper family planning retrenchment would, however, put millions of lives at risk.</p>
<h2>US family planning assistance</h2>
<p>Trump’s proposed <a href="http://www.reuters.com/article/us-usa-trump-budget-state-idUSKBN16N0DQ">28 percent cut to the foreign aid and diplomacy</a> budget could translate into a US$175 million reduction in USAID’s family planning spending from 2015 levels. </p>
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<p>The magnitude of these cuts pales in comparison with the nation’s $4 trillion budget and the administration’s overall plan to <a href="https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/2018_blueprint.pdf">reduce non-military spending by $54 billion</a>. But the potential impact on the lives of women, children and men in developing countries outweighs their monetary value.</p>
<p>Rolling back U.S. support for family planning in developing countries is dangerous for two main reasons. First, contraception saves lives by limiting the total number of pregnancies, including those endangering mothers’ lives. Second, as I explain in my book, “<a href="http://www.cambridge.org/us/academic/subjects/politics-international-relations/african-government-politics-and-policy/intimate-interventions-global-health-family-planning-and-hiv-prevention-sub-saharan-africa?format=HB">Intimate Interventions in Global Health</a>,” past U.S. funding for family planning had an unintended upside: it helped form the backbone of many countries’ early HIV-prevention efforts and created organizations that remain central to the response to HIV. </p>
<p>The U.S. government has identified <a href="https://www.usaid.gov/what-we-do/global-health/family-planning">24 priority countries for family planning assistance</a>, including 16 in sub-Saharan Africa. In these countries, on average only half of women who wish to avoid pregnancy are <a href="https://www.usaid.gov/what-we-do/global-health/family-planning">using modern contraception</a>. That means U.S. funding can go a long way toward helping these women have the number of children they desire.</p>
<h2>Contraception saves lives and strengthens health systems</h2>
<p>Contraception lets women and men exercise reproductive freedom and averts maternal and infant deaths. According to the <a href="https://www.guttmacher.org/article/2016/05/just-numbers-impact-us-international-family-planning-assistance">Guttmacher Institute</a>, which researches sexual and reproductive health, U.S. foreign assistance for family planning in 2016 funded contraceptive services for 27 million girls, women and couples, helping avert 6 million pregnancies and 11,000 maternal deaths.</p>
<p>Fewer unintended pregnancies also means fewer maternal deaths due to unsafe abortion. Sub-Saharan Africa has both the world’s highest fertility rate and the <a href="http://worldabortionlaws.com/">least access to safe abortion</a>. U.S. family planning assistance in 2016 helped <a href="https://www.guttmacher.org/article/2016/05/just-numbers-impact-us-international-family-planning-assistance">prevent 2 million unsafe abortions</a> resulting from unplanned pregnancies.</p>
<p>For the 22 priority nations with good data, the fertility rates average 4.5 children per woman, ranging from 2.3 in Bangladesh and India to 6.6 in the Democratic Republic of the Congo. In comparison, the <a href="http://www.prb.org/DataFinder/Geography/Data.aspx?loc=312">U.S. total fertility rate</a> is 1.9 children per woman.</p>
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<p>Designed to slow global population growth and encourage socioeconomic development, U.S. spending on family planning in sub-Saharan Africa in the 1980s also yielded benefits beyond family planning.</p>
<p>Specifically, U.S.-supported family planning organizations became the first responders when the HIV epidemic emerged. For example, to promote contraception, a group of Nigerian medical professionals founded the <a href="http://www.sfhnigeria.org/">Society for Family Health in Nigeria</a> in 1985 <a href="http://www.psi.org/country/nigeria/#about">in partnership with PSI</a>, a U.S. nonprofit previously known as Population Services International that gets government funding. </p>
<p>In the 1990s, the HIV epidemic took off in Nigeria amid political chaos and government denial of the disease. As one of the main sources for condoms, the Society for Family Health helped prevent the spread of the as-yet untreatable virus. It remains both a key player in the response to HIV and a major recipient of <a href="http://files.kff.org/attachment/report-foreign-ngo-engagement-in-u-s-global-health-efforts">U.S. global health funding</a>. Similar results <a href="http://www.jiasociety.org/index.php/jias/article/view/17511">were echoed across Africa</a>.</p>
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<a href="https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165053/original/image-20170412-25882-2935n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The United Nations Population Fund provides family planning and health services in India, where it also seeks to improve maternal health.</span>
<span class="attribution"><a class="source" href="http://india.unfpa.org/en/news/10-new-year%E2%80%99s-resolutions-help-change-world">UNFPA</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>In “Intimate Interventions in Global Health,” I also detail how U.S. family planning helped build infrastructure for women’s health research in Senegal that became useful for the fight to stop HIV’s spread. Key researchers working at the Social Hygiene Institute, including Senegalese doctors Soulemayne Mboup and Ibrahim Ndoye, argued in the 1980s that effectively running family planning programs required comprehensive knowledge of sexually transmitted infections among women. USAID agreed and invested in laboratory capacity, which ultimately supported Senegal’s successful response to the epidemic.</p>
<h2>What to expect once the US cuts global health spending</h2>
<p>For sure, the impact of the U.S. government’s cessation of United Nations Population Fund support will be largely symbolic. In 2015, Washington’s <a href="http://www.unfpa.org/donor-contributions">$76 million contribution</a> amounted to about 7.5 percent of <a href="http://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_2015_Annual_Report.pdf">the global agency’s $993 million budget</a>. </p>
<p>Previously, when the U.S. has refused to support the global agency, other countries stepped in to <a href="https://www.cgdev.org/doc/Resources-at-UNFPA.pdf">fill the gap</a>. It’s unclear whether other countries or additional funders, like the Bill and Melinda Gates Foundation, would be willing to do so if Congress embraces Trump’s broader proposed cuts to global health assistance. (The Gates Foundation spent <a href="http://www.gatesfoundation.org/Who-We-Are/Resources-and-Media/Annual-Reports/Annual-Report-2015">$144 million on family planning in 2015</a>, slightly less than a quarter of what USAID spent on family planning that year.)</p>
<p>Family planning funding alone could not stop HIV from infecting <a href="https://www.aids.gov/hiv-aids-basics/hiv-aids-101/statistics/">the 1.2 million Americans living with the virus</a> that causes AIDS, but it did help slow the virus’s spread in sub-Saharan Africa, particularly when <a href="http://kff.org/global-health-policy/timeline/global-hivaids-timeline/">governments widely denied</a> the need to make treatment and prevention high priorities.</p>
<p>Cutting U.S. funding for global health efforts, including family planning, would leave the poorest countries <a href="https://theconversation.com/how-the-trump-budget-undercuts-security-risks-posed-by-pandemics-75281">ill-prepared for epidemics, pandemics</a> and other emerging health threats – including the kinds that <a href="http://www.vox.com/2017/3/4/14803596/trump-pandemic-response-global-health-cdc">easily cross borders</a>. This negligible budgetary savings will ultimately cost rich and poor nations in the future.</p><img src="https://counter.theconversation.com/content/75813/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Sullivan Robinson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Contraception saves lives, and U.S. spending on it abroad had an unintended upside when it formed the backbone of early HIV prevention efforts.Rachel Sullivan Robinson, Associate Professor, American University School of International ServiceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/747982017-04-11T02:00:45Z2017-04-11T02:00:45ZWill Trump’s cuts inspire more DIY foreign aid?<figure><img src="https://images.theconversation.com/files/162470/original/image-20170325-12127-zjwg8j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Paul Odihambo shows off a bore well in his village outside of Kisumu, Kenya that a DIY aid group donated. </span> <span class="attribution"><span class="source">Susan Appe</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Running on a shoestring budget, <a href="http://www.futureinourhandsusa.com/">Future in Our Hands-USA</a> helps people living almost 7,500 miles away in Kisumu, Kenya, get clean water from new wells. The tightly focused and volunteer-driven nonprofit based in Clarence, New York, also encourages school attendance by paying fees and lends money to local women’s cooperatives.</p>
<p>More than 11,000 do-it-yourself (DIY) aid groups like this one scattered across the country power small-scale development initiatives. Given how much of their work is an unpaid labor of love, it’s hard to gauge their impact.</p>
<p>With <a href="http://www.reuters.com/article/us-usa-trump-budget-state-idUSKBN16N0DQ">U.S. funding for overseas economic and development projects slated for deep cuts</a> – the Trump administration’s proposed budget would slash foreign aid and diplomacy spending by 28 percent – will this kind of giving ramp up as concerned Americans seek to fill needs abroad that their government won’t? My own research suggests that steep cuts would further motivate American donors and volunteers to engage in small-scale development initiatives.</p>
<h2>‘Altruism from afar’ powers the spread of MONGOs</h2>
<p>Linda Glaeser, one of Future in Our Hands-USA’s founders, first traveled to Kenya with her niece, a teacher who had volunteered in Kisumu, a city on the shore of Lake Victoria. Glaeser says she was saddened when she saw children facing health problems that were directly related to the lack of access to clean water. She decided something needed to be done.</p>
<p>“I might not have specific skills, but I have heart,” says Glaeser, a physical therapist who lives in Clarence, a Buffalo suburb with about 31,000 residents.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/162949/original/image-20170328-3803-w2ly5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/162949/original/image-20170328-3803-w2ly5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=840&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162949/original/image-20170328-3803-w2ly5x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=840&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162949/original/image-20170328-3803-w2ly5x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=840&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162949/original/image-20170328-3803-w2ly5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1055&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162949/original/image-20170328-3803-w2ly5x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1055&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162949/original/image-20170328-3803-w2ly5x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1055&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Linda Glaeser presents an award to students receiving Future in Our Hands-USA scholarships.</span>
<span class="attribution"><span class="source">Courtesy of Linda Glaeser</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Like many small aid groups of its kind, Glaeser’s group has no paid staff. It pumps 97 percent of the money it raises annually, about US$45,000, into its Kenyan projects. The rest covers operating expenses like website maintenance and bank fees. As with most DIY foreign aid groups, most of its board members and donors belong to the Glaeser’s personal and professional networks. Accountability stems from trust and relationships in the absence of formal mechanisms.</p>
<p>Spurred by the acceleration of globalization in the 1990s, DIY aid groups – sometimes called <a href="http://foreignpolicy.com/2009/11/17/an-ngo-by-any-other-name/">MONGOs</a>, as in “my own nongovernmental organization” – are growing more common.</p>
<p>Sociologists Ann Swidler and Susan Cotts Watkins call this trend “<a href="https://books.google.com/books?id=GglpDQAAQBAJ&dq=%E2%80%98altruism+from+afar%E2%80%99&source=gbs_navlinks_s">altruism from afar</a>.” These initiatives differ from traditional foreign-funded aid because volunteers do most of the work. Most lack formal training in international development or nonprofit management. </p>
<h2>Number of DIY aid groups soars</h2>
<p>The number of amateur-run global do-good groups based in the United States is soaring. </p>
<p>International development professor <a href="https://spea.indiana.edu/faculty-research/directory/profiles/faculty/full-time/schnable-allison.html">Allison Schnable</a> at Indiana University, Bloomington, estimates that there were more than <a href="https://academic.oup.com/socpro/article/62/2/309/1618650/New-American-Relief-and-Development-Organizations">11,000 of them in 2010, up from 1,000 two decades earlier</a>, operating in every state in the nation. Nearly 60 percent of these initiatives had an annual budget below $25,000. </p>
<p>The spread of mobile devices and digital communications tools in countries rich and poor since 2010, including Facebook and Whatsapp, has simplified the logistics of running DIY aid efforts. That means the current number is surely much higher.</p>
<p>Along with three Binghamton University doctoral students, I have identified 147 DIY foreign aid groups headquartered in New York state but located outside New York City – a traditional hub for bigger aid groups. Like Future in Our Hands-USA, these groups primarily specialize in water and sanitation, education and female empowerment. Among other things, we looked into what motivates Americans to donate their money and volunteer their time to these small-scale development initiatives.</p>
<p>For example, <a href="http://www.etc-nepal.org/">Educate the Children</a> sponsors school scholarships and lends women small amounts of money to buy garden supplies in Nepal. The Ithaca-based group arose when its founder, Pamela Carson, visited Nepal in 1989 and wanted to help alleviate the poverty she saw there. Through appeals via social media and fundraising events, Educate the Children manages to give about $100,000 annually to its projects in Nepal.</p>
<p>Thomas and Liz Brackett founded the <a href="http://www.brackettfund.org/">Brackett Refugee Education Fund</a> after living with refugees in Thailand for six months as volunteers in 1997 and making yearly visits to do additional service-related work. The Hamilton, New York-based nonprofit aid group, also running on about $100,000 a year, covers school costs for Burmese refugee families living in India, Bangladesh and Thailand, as well as internally displaced people in Myanmar. </p>
<h2>Will foreign aid cuts boost DIY foreign aid?</h2>
<p>U.S. private giving in 2015 to international causes totaled $15.75 billion, 4 percent of the private donations charities of all kinds received, according to the <a href="https://givingusa.org">Giving USA 2016</a> report, a publication of Giving USA Foundation, researched and written by the Indiana University Lilly Family School of Philanthropy.</p>
<p>Those aid flows complement the roughly $25 billion <a href="https://www.washingtonpost.com/graphics/world/which-countries-get-the-most-foreign-aid/">the federal government</a> has long spent yearly on economic and development aid.</p>
<p>Americans donate most often in response to humanitarian crises, such as Nepal´s earthquake, the Syrian refugee crisis and West Africa’s Ebola epidemic. It’s unclear how much of the money Americans spent on aid supported small-scale development initiatives. Interestingly, while overall charitable giving grew 4 percent from 2014 to 2015 to a record $373.25 billion, international causes soared 17.5 percent, according to <a href="https://givingusa.org/giving-usa-2016/">Giving USA 2016</a> data.</p>
<p>Fans of the DIY foreign aid “revolution,” as Nicholas Kristof called it in <a href="http://www.nytimes.com/2010/10/24/magazine/24volunteerism-t.html">a 2010 New York Times column</a>, tend to attribute the trend’s rise to the growing exchanges of people and ideas through international travel, study abroad, service and mission trips, Peace Corps stints and other experiences. The motivation behind these small-scale development initiatives has not previously been linked to official foreign aid spending cuts. Rather, it has been driven by very individual and personal experiences.</p>
<h2>The future of US foreign aid</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=494&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=494&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=494&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=621&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=621&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164727/original/image-20170410-31893-h9qcrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=621&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Through their DIY foreign aid efforts, Americans can feel they are fighting global poverty.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/wildrose115/27623264486/in/photolist-J5Ys9N-dDRp3W-bvXQZZ-8jzvTU-6nJKJu-7odsDE-ap1auw-9tkkhW-7Sj7nt-6tvoxt-8Li6Rk-J6rjP-dKtFBp-gR1kL-D7RaZi-dTikAW-TED1WK-RP6rK9-Ts2jea-gKD2Eq-7oU666-TAr9og-SW6CsX-Sbr2u7-SYWQxc-TpWK6a-Tf3YgT-27i8Dn-SjD9Fu-6YCQgs-6jWpob-SCCKrc-TrspR2-Trg6yy-6q3Yyc-RqoiAV-qJS36m-RLqyyB-RwrzYU-59A81b-dVy7PS-SKGfGH-bkpnsw-SasG5V-j32XTD-RJidXW-oCpomm-okSvMS-s2T93f-onWKYE">EL gazette</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Small-scale development initiatives offer an alternative to larger aid efforts that development scholars and practitioners alike <a href="https://www.theguardian.com/global-development-professionals-network/2016/mar/13/do-international-ngos-still-have-the-right-to-exist">have criticized</a> for failing to wipe out global poverty after decades of constant effort. </p>
<p>DIY aid’s low operating costs and its emphasis on personal relationships and long-term impact rather than short-term outcomes is inherently appealing to donors who want to know where their money is going and how it is spent. </p>
<p>But there are challenges to small-scale development initiatives. Their voluntary nature and tight budgets can <a href="http://foreignpolicy.com/2010/10/26/dont-try-this-abroad/">oversimplify barriers to development</a>. And while informal relationships based on personal networks can be considered a strength for donors, the long-term sustainability of these relationships has not been entirely tested. </p>
<p>Providing a channel for people who want to make a difference and take action with their time and money makes sense. However, more evidence is needed to assess their sustainability, effectiveness and comparative advantages over bigger, more professional aid organizations. </p>
<p>Can private individuals fill the foreign aid gap if Congress goes along with the Trump administration’s request to slash funding? Small-scale development initiatives and DIY foreign aid might be the best way for Americans to at least feel they are fighting global poverty. Whether or not it can fill the gaps produced by the pending government foreign aid cuts is hard to predict. However, there are signs that looming budget cuts are inspiring people like Glaeser to work even harder.</p>
<p>At their March meeting, Future in Our Hands-USA’s board planned a garage sale. If they meet their goal, it will raise several hundred dollars for projects in Kenya.</p>
<p>Whether the funds pay for a new well, cover transportation costs for HIV/AIDs patients or finance schools for girls, these residents of Clarence, New York will know they’ve made a difference for people who live a world away from them.</p><img src="https://counter.theconversation.com/content/74798/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Appe does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With steep budget cuts looming, a growing number of tiny volunteer-driven organizations are delivering aid on their own. Will the Trump administration inspire even more small-scale global giving?Susan Appe, Assistant Professor of Public Administration at Binghamton University, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/750402017-04-10T00:36:42Z2017-04-10T00:36:42ZWhat Trump’s foreign aid cuts would mean for global democracy<figure><img src="https://images.theconversation.com/files/164305/original/image-20170406-16654-1co12v5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The government-funded International Republican Institute, a nonprofit, supports democratic efforts like this voter education campaign in Burma.</span> <span class="attribution"><a class="source" href="http://www.democracyspeaks.org/blog/burma%E2%80%99s-elections-opportunity-build-lessons-learned">International Republican Institute</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>President Donald Trump’s proposed budget would slash State Department spending by <a href="https://www.washingtonpost.com/world/national-security/state-departments-28-percent-cuts-hit-foreign-aid-un-and-climate-change/2017/03/15/294d7ab8-0996-11e7-a15f-a58d4a988474_story.html?utm_term=.ebf7618d704e">28 percent</a>, drastically reducing U.S. foreign aid flows.</p>
<p>Will he prevail? Senator Lindsey Graham, a South Carolina Republican, <a href="http://www.bbc.com/news/world-us-canada-39289416">has said bluntly</a> “It’s not going to happen.” But the White House’s proposal is emblematic of an ongoing, broader foreign policy shift. </p>
<p>Specifically, Trump’s <a href="http://carnegieendowment.org/2017/01/05/prospects-for-u.s.-democracy-promotion-under-trump-pub-66588">actions and comments</a> suggest a <a href="https://www.ethicsandinternationalaffairs.org/2017/democracy-promotion-trump-administration/">deep skepticism</a> regarding support for democracy abroad. Consequently, democracy assistance – a relatively small but often pivotal type of foreign aid on which the United States Agency for International Development (USAID) and the State Department <a href="http://beta.foreignassistance.gov/categories/Democracy-Human-Rights-Governance">plan to spend</a> US$2.72 billion in 2017 – seems likely to be hit hard.</p>
<p>If it is, U.S. foreign policy under Trump will look fundamentally different than it has under previous presidents dating back at least to Ronald Reagan. What’s more, my research suggests that the shift spells trouble for democracy around the world. </p>
<p>Although U.S. democracy assistance is not perfect, drastic budget cuts would sever a lifeline to pro-democracy activists around the world. </p>
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<h2>What is democracy aid?</h2>
<p>Democracy assistance is a type of foreign aid the U.S. government funds in nearly 100 countries with the explicit goal of supporting democracy. Whether it consists of encouraging women to run for office in <a href="https://www.usaid.gov/results-data/success-stories/increasing-access-women-politics">Kyrgyzstan</a> or building the capacity of local civil society organizations in <a href="http://www.ned.org/region/middle-east-and-northern-africa/tunisia-2015/">Tunisia</a>, this form of assistance always aims to enhance some aspect of democracy. It supports transitions to democracy and shores up existing democratic institutions.</p>
<p>Democracy assistance began in the 1980s. Until that point, the U.S. government supported overseas political parties and dissidents covertly and on an ad hoc basis. In 1983, the United States established the National Endowment for Democracy (NED), a quasi-private foundation dedicated to supporting democracy abroad. As the Cold War ended, USAID and the State Department also began funding democracy assistance consistently.</p>
<p>These institutions, which I examine in “<a href="http://www.cambridge.org/cr/academic/subjects/politics-international-relations/international-relations-and-international-organisations/taming-democracy-assistance-why-democracy-promotion-does-not-confront-dictators">The Taming of Democracy Assistance</a>,” my book on the topic, often don’t deliver money or services directly. Instead, they fund a variety of American and international nonprofits (and a few for-profit organizations). Ideally, funding democracy assistance via nonprofits and other nongovernmental entities helps insulate it from U.S. government influence. Of course, that is not always so simple in practice.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=474&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=474&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=474&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=596&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=596&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164132/original/image-20170405-14636-6zl5cj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=596&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Democracy assistance flows into nonprofits and other institutions often known by their abbreviations.</span>
<span class="attribution"><a class="source" href="http://www.fpri.org/article/2013/06/reforming-the-democracy-bureaucracy/">Foreign Policy Research Institute</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Democracy assistance rarely grabs headlines. Some of its critics argue that it involves <a href="https://www.jacobinmag.com/2017/01/us-intervention-russia-elections-imperialism-latin-america/">meddling</a> in other countries’ elections (allegedly with both a <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2017/03/20/putin-is-waiting-to-see-whether-trump-will-fund-pro-democracy-programs/">right-wing</a> and <a href="https://foreignpolicy.com/2017/03/28/soros-gop-letter-open-society-macedonia-albania/">left-wing</a> bias), implying an equivalence to Russia’s actions during the 2016 U.S. presidential election. <a href="https://www.amazon.com/Taming-Democracy-Assistance-Promotion-Dictators/dp/1107642205/ref=mt_paperback?_encoding=UTF8&me=">My research</a> suggests otherwise.</p>
<p>Democracy assistance efforts are indeed sometimes partisan, but have grown markedly less so since the Cold War ended. Indeed, as <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2015/11/09/democracy-promotion-is-failing-heres-why/?utm_term=.2ab6410c5296">I explained on the Washington Post’s Monkey Cage blog</a>, it has become rare for these programs to promote radical political change today. In some cases, democracy assistance has even reinforced authoritarian regimes, as was the case when international aid offered <a href="https://foreignpolicy.com/2013/06/03/reforming-the-democracy-bureaucracy/">support for a parliament in Azerbaijan</a> that was not freely elected. </p>
<h2>What’s at stake?</h2>
<p>Despite these flaws, eliminating democracy assistance projects could wreak damage to democracy three ways. </p>
<p>First, <a href="https://www.jstor.org/stable/40060164">scholarly</a> <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2478.2010.00635.x/pdf">evidence</a> on U.S. democracy assistance finds that it is, on average, associated with increases in countries’ overall levels of freedom. Second, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1540-5907.2010.00501.x/abstract">research</a> also suggests that democracy assistance can help countries maintain peace after civil conflict. Third, specific types of democracy assistance – such as support for international and domestic <a href="http://www.cornellpress.cornell.edu/book/?GCOI=80140100592790">election</a> <a href="http://press.princeton.edu/titles/9748.html">observers</a> – have proven successful at deterring electoral fraud.</p>
<p>A good example of how U.S. democracy assistance has successfully helped advance democratic transitions comes from <a href="http://www.aforcemorepowerful.org/films/bdd/">Serbia’s nonviolent student movement</a> in 2000. There, the brutal dictator Slobodan Milošević – guilty of war crimes associated with the conflicts in the former Yugoslavia – was brought down by a popular movement supported with training from U.S. nonprofits.</p>
<p>Cutting democracy assistance would also represent a major break in U.S. foreign policy. </p>
<p>The origins of American democracy promotion date back at least <a href="https://www.washingtonpost.com/news/democracy-post/wp/2017/03/20/is-this-the-end-of-americas-role-as-a-defender-of-freedom/?utm_term=.b012dc37ef98">a century</a>. On April 2, 1917, President Woodrow Wilson made his famous speech telling Congress, “<a href="http://historymatters.gmu.edu/d/4943/">The world must be made safe for democracy</a>.” Leaders from both major U.S. political parties have sought ever since to promote democracy overseas with the logic that it is the right thing to do as well as the smart thing to do.</p>
<p>Among other things this credo stems from the belief that democracy fosters peaceful relations between nations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/164168/original/image-20170405-14629-drx8hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/164168/original/image-20170405-14629-drx8hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=367&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164168/original/image-20170405-14629-drx8hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=367&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164168/original/image-20170405-14629-drx8hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=367&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164168/original/image-20170405-14629-drx8hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=461&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164168/original/image-20170405-14629-drx8hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=461&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164168/original/image-20170405-14629-drx8hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=461&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Participants in this Mayan ceremony in Guatemala’s Quiche province wanted to discourage illegal campaign activity in the 2015 elections held there.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/usaid_guatemala/25972702773/in/photolist-rFugD6-8tXmuY-qJzNuY-rFtFJ3-rp8B94-rp2bv9-8tUgrV-nEXPPM-notn2f-notaYb-oiw6MP-dkxUEf-bonPyC-notaZU-o23NEz-oiwfPB-oik74w-o23Lmr-o22ArG-okhdYr-o22KQF-o22NvE-pvXTmU-dU8fwo-dU2C2K-eVUz6m-eVUz9U-eVUz6y-9hH2Zm-Fz7TEe-qJzNvu-rp195h-qJN5UX">Sara Barker/National Democratic Institute</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Of course, the United States counts among its allies many authoritarian states like <a href="https://www.nytimes.com/2017/03/14/opinion/the-us-should-not-be-egypts-accomplice.html?_r=0">Egypt</a> and <a href="http://www.cnn.com/2016/04/20/opinions/us-saudi-bad-marriage-opinion-miller/">Saudi Arabia</a>. In such cases, past U.S. presidents have mixed pro-democracy rhetoric with anti-democracy policies. Yet President Trump is abandoning even the pro-democracy rhetoric, and activists are worried. </p>
<p>As one Egyptian journalist <a href="https://www.buzzfeed.com/borzoudaragahi/egypts-rulers-are-hailing-president-trump-democracy?utm_term=.wizm611a0#.xw6RBMMLw">recently said</a> about this situation, “It’s not a big space, but the rhetoric gives us some space.”</p>
<h2>What’s next?</h2>
<p>If the U.S. democracy assistance project survives the Trump administration but spending declines sharply, a <a href="https://rowman.com/ISBN/9781538101841/Does-Democracy-Matter?-The-United-States-and-Global-Democracy-Support">recent study</a> suggests two lessons about how it could spend the remaining funds most effectively. </p>
<p>First, this kind of aid works best in countries that are already partly free. In such settings, domestic actors are likely to be seeking international support and aid is less likely to be co-opted by authoritarian governments. </p>
<p>Second, democracy assistance programs tend to be the most successful in countries where the U.S. government can back them up with diplomacy. By this logic, it makes more sense to support democracy assistance in Tunisia, where democratically elected leaders <a href="http://www.washingtontimes.com/news/2017/mar/13/khemaies-jhinaoui-tunisia-foreign-minister-hopes-f/">cooperate with the United States on counterterrorism</a>, than it does in Egypt, where the United States maintains a <a href="http://www.vox.com/world/2017/4/3/15160358/trump-egypt-abdel-fattah-el-sisi-white-house">close relationship</a> with the military dictatorship of Abdel Fattah el-Sisi.</p>
<p>Research on U.S. democracy assistance suggests that continuing to aid democracy abroad is consistent with a century-long tradition in U.S. foreign policy and that it can advance democracy worldwide. However, even with continued support, American democracy promoters face clear challenges. These challenges include problems with the <a href="http://foreignpolicy.com/2016/01/27/look-homeward-democracy-promoter/">state of democracy</a> in the United States that have been building for several years as well as <a href="http://www.resurgentdictatorship.org/">growing restrictions</a> on civil society activity and foreign aid around the world. </p>
<p>Even barring steep spending cuts, democracy assistance is likely to have a difficult next four years.</p><img src="https://counter.theconversation.com/content/75040/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Bush is a Senior Fellow at the Foreign Policy Research Institute. </span></em></p>U.S. democracy assistance is not perfect. But drastic cuts to that slice of the federal budget would sever a lifeline to pro-democracy activists around the world.Sarah Bush, Assistant Professor of Political Science at Temple University, Temple UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/748102017-04-07T01:36:32Z2017-04-07T01:36:32ZUS foreign aid, explained<figure><img src="https://images.theconversation.com/files/163503/original/image-20170331-27277-p87hyp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If implemented, President Trump's proposed foreign aid cuts would have many repercussions.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/49482478@N06/4689443682">Kendra Helmer/USAID</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>President Donald Trump seeks to fulfill his campaign promise to “put America first” in his proposed 2018 budget. </p>
<p>“This includes deep cuts to foreign aid,” Trump said in his <a href="https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/2018_blueprint.pdf">opening message to his proposed budget</a>. “It is time to prioritize the security and well-being of Americans, and to ask the rest of the world to step up and pay its fair share.”</p>
<p>His budget would slash funding for the State Department and U.S. Agency for International Development (USAID) to US$25.6 billion, down 28 percent from the current level. Although the budget doesn’t specify how much USAID alone would lose, if enacted, these deep cuts would significantly disrupt America’s ability to deliver foreign aid.</p>
<p>With foreign aid on the chopping block, it’s important for Americans to understand how it works, who benefits from it and how U.S. contributions stack up. I’ve done that here while attempting to debunk three common myths:</p>
<ol>
<li>The U.S. spends too much on foreign aid.</li>
<li>The U.S. spends more than its fair share on foreign aid compared to other countries. </li>
<li>Corrupt governments squander U.S. foreign aid.</li>
</ol>
<p>My research is on nonprofits, which in the foreign aid sphere are often called nongovernmental organizations (NGOs). These groups are <a href="https://www.usaid.gov/partnership-opportunities/ngo">key actors in foreign aid</a>. They deliver humanitarian services on the ground and, increasingly, are the direct recipients of foreign aid from governments such as the United States. </p>
<h2>What is foreign aid?</h2>
<p>Foreign aid consists of money, goods and services – like training – that official government agencies provide to other countries. Foreign aid falls into two broad categories: economic assistance and military (or security) assistance.</p>
<p><strong>Economic assistance</strong> includes all programs with development or humanitarian objectives. That tends to include projects related to health, disaster relief, the promotion of civil society, agriculture and the like. Most economic aid dollars come from the State Department budget, including spending allocated by USAID.</p>
<p>According to data from the nonprofit <a href="http://securityassistance.org/content/economic-aid-dashboard">Security Assistance Monitor</a>, the top five recipients of U.S. economic assistance in 2015, the most recent year for which comparative data are available, were Afghanistan, Kenya, Ethiopia, Nigeria and Tanzania.</p>
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<p>Official development assistance (ODA) constitutes the vast majority of U.S. economic assistance. This funding must be “concessional,” which means that some portion of it must consist of grants rather than loans. Military expenditures and peacekeeping expenditures don’t count. </p>
<p>Only countries that are considered low- and middle-income based on their gross national income (GNI) per capita are eligible. For example, Israel, the second-largest recipient of U.S. military assistance (see below), is ineligible for those overseas development funds, although it did receive <a href="http://securityassistance.org/content/economic-aid-dashboard">$10 million in other economic aid</a> in 2015. </p>
<p>While taxpayers are spending just a few bucks each on ODA, the impact is profound, <a href="https://www.usaid.gov/what-we-do/agriculture-and-food-security/food-assistance">saving millions of people from hunger</a>, averting <a href="https://www.usaid.gov/what-we-do/working-crises-and-conflict/responding-times-crisis">the worst of natural disasters like droughts and flooding</a>, tackling life-threatening diseases like <a href="https://www.usaid.gov/what-we-do/global-health/tuberculosis">tuberculosis</a> and <a href="https://www.usaid.gov/what-we-do/global-health/malaria">malaria</a>, and more.</p>
<p><strong>Military aid</strong> includes military financing, which our allies use to buy weapons, funding intended to advance counterterrorism and anti-narcotics initiatives, and money spent on efforts related to military operations in Iraq, Afghanistan and other nations. Most military aid dollars come from either the State Department’s or the Pentagon’s budget.</p>
<p>The <a href="http://securityassistance.org/content/security-aid-dashboard">top five recipients of U.S. military assistance in 2015</a> were Afghanistan, Israel, Iraq, Egypt and Pakistan. </p>
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<h2>Myth #1: US spends too much on foreign aid</h2>
<p>The United States consistently spends only about 1 percent of its budget on foreign aid – including military and economic support. The 2015 aid tab <a href="http://explorer.usaid.gov/aid-dashboard.html#2015">totaled $43 billion</a>. </p>
<p>Americans tend to believe that their government spends a far bigger share of its budget on foreign aid than it does. In a survey <a href="http://kff.org/global-health-policy/poll-finding/data-note-americans-views-on-the-u-s-role-in-global-health/">the Kaiser Family Foundation</a> published two years ago, it found that, on average, Americans believe that foreign aid accounts for more than a quarter of the budget. Only 5 percent of those polled answered correctly that foreign aid constituted 1 percent or less of total federal spending. </p>
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<h2>Myth #2: US spends more than its fair share</h2>
<p>According to the Organization for Economic
Co-operation and Development (OECD), the United States is by far the leading source of economic assistance dollars. In 2015, it contributed <a href="http://www2.compareyourcountry.org/oda?cr=20001&cr1=oecd&lg=en&page=0">$31 billion in ODA</a>, far outpacing the $18.7 billion spent by the United Kingdom, the second-biggest source of that kind of aid. </p>
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<p>That only tells part of the story, however. The United States spends very little on foreign aid relative to the size of its economy, particularly compared with other rich countries. The U.S. spent about 0.17 percent of its GNI on ODA in 2015. By comparison, Sweden, the top contributor by this metric, gave 1.4 percent of its GNI in overseas development aid that year. The United States ranks among the <a href="http://www2.compareyourcountry.org/oda?cr=20001&cr1=oecd&lg=en&page=0">bottom third of OECD countries</a>, close to Portugal and Slovenia, in ODA spending.</p>
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<p>In 1970, the United Nations General Assembly agreed that “economically advanced countries” would aim to <a href="http://www.oecd.org/dac/stats/the07odagnitarget-ahistory.htm">direct at least 0.7 percent of their national income</a> to ODA. Although developed countries have repeatedly mentioned this target in agreements and at summits since then, very few countries have reached that goal. In 2015, only six countries met the 0.7 percent target. The OECD average is just 0.3 percent – almost twice the 0.17 percent the U.S. provides. </p>
<h2>Myth #3: Corrupt governments squander US aid</h2>
<p>You may think that foreign aid consists of government-to-government transfers of money. But governments channel most aid through nonprofits, public-private partnerships, <a href="https://www.devex.com/news/top-usaid-contractors-for-2015-88181">private companies</a> like Chemonics International and John Snow Incorporated, and multilateral organizations such as the United Nations and the World Bank. </p>
<p>In fact, according to the <a href="https://stats.oecd.org/Index.aspx?DataSetCode=CRS1">OECD’s Creditor Reporting System</a>, only 37 percent of U.S. ODA went directly to governments in 2015 – and that includes other countries distributing the assistance rather than receiving it. The rest of that funding bypassed governments altogether: NGOs received 26 percent of the money, multilateral organizations 20 percent, and other organizations, such as universities and research institutes, 18 percent.</p>
<p>When <a href="https://doi.org/10.1017/S0020818315000302">Simone Dietrich at the University of Essex</a> researched this question, she found that the United States chooses to outsource foreign aid to NGOs especially in countries like Sudan and Sri Lanka with bad governance and more corrupt leaders who are likely to squander or swipe those funds.</p>
<p>It’s impossible to argue that corrupt governments never squander U.S. foreign aid. They do. But it is important to understand that most aid never enters the coffers of those corrupt governments in the first place. </p>
<h2>Even without Trump’s proposed cuts, US fails to lead</h2>
<p>As Congress decides whether to follow Trump’s lead by slashing foreign aid spending, lawmakers should take into account the fact that U.S. taxpayers already spend far less than our global peers on foreign aid.</p>
<p>Even without these prospective cuts, other countries, including Canada, the United Kingdom and Germany, are paying far more on economic assistance for the world’s poorest people as a share of their economy than we do. Slashing foreign aid would damage U.S. credibility with our allies, reduce U.S. influence around the globe and – a group of more than 120 retired generals and admirals predict – <a href="http://thehill.com/policy/defense/321395-retired-generals-urge-congress-to-fully-fund-diplomacy">make Americans less safe</a>.</p><img src="https://counter.theconversation.com/content/74810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joannie Tremblay-Boire does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As President Trump puts U.S. foreign aid on the chopping block, few Americans know much about it. Perhaps even fewer realize that the U.S. lags behind its peers on this front.Joannie Tremblay-Boire, Assistant Professor, Department of Public Management and Policy, Andrew Young School of Policy Studies, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/752812017-04-05T01:09:30Z2017-04-05T01:09:30ZHow the Trump budget undercuts security risks posed by pandemics<figure><img src="https://images.theconversation.com/files/163652/original/image-20170403-21979-19gc0e.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"> Women in rural Malawi, outside an AIDS hospital. AIDS was the first of the ‘new’ pandemic threats, after bird flu.</span> <span class="attribution"><span class="source">Author provided. </span>, <span class="license">Author provided</span></span></figcaption></figure><p>President Trump proposed a <a href="https://www.nytimes.com/2017/02/27/us/politics/trump-budget-military.html">US$54 billion military budget increase</a> to solidify the security of our nation. However, the government also recognizes pandemic threats as an issue of national security – one that knows <a href="http://bit.ly/1iyixjV">no borders</a>. </p>
<p>In the last four years, we have faced the Ebola epidemic – contained after significant loss of life – and Zika, which is still not contained. Collectively, we will feel these effects for a generation, while children born with Zika-related defects and their families will feel the effects every day of their lives.</p>
<p>The U.S. is a leading member of the Global Health Security Agenda (GHSA), a growing international partnership created to respond to <a href="https://www.ghsagenda.org">infectious disease threats</a>. Yet the Trump budget slashes funding for the very agencies mandated to prevent pandemics. Take, for example, the <a href="https://www.nytimes.com/aponline/2017/02/28/us/politics/ap-us-trump-diplomatic-cutbacks.html">37 percent cut</a> to the $50 billion State Department and United States Agency for International Development (USAID) budget, more than <a href="https://www.theguardian.com/global-development/2017/feb/27/trump-first-budget-us-foreign-aid">one-third</a> of which targets global health security. As a global health researcher, I think this reveals a grave lack of understanding of the nuances and complexity of this national security issue.</p>
<p>The way the military protects America’s welfare is straightforward. The way that other U.S. agencies prevent pandemics is less understood. That it’s complicated shouldn’t stop our commitment to it. </p>
<h2>Threats are closer than we realize</h2>
<p>There are imminent threats that aren’t in the realm of hypothetical. Here’s an example: In January of this year, the government issued a travel warning in response to an active outbreak of H7N9 <a href="https://wwwnc.cdc.gov/travel/notices/watch/avian-flu-h7n9">bird flu in China</a>. </p>
<p>This strain of avian flu is worrisome because a few small mutations would allow it to spread from <a href="https://www.cdc.gov/flu/avianflu/h7n9-virus.htm">person to person</a>. This could be the next pandemic to sweep the globe. </p>
<p>Historically speaking, we are overdue for a bird flu disaster. They have been documented over the past two centuries and appear every 40 years on average; the last one was in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862331/">1969</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163656/original/image-20170403-21976-1h63xjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163656/original/image-20170403-21976-1h63xjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163656/original/image-20170403-21976-1h63xjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163656/original/image-20170403-21976-1h63xjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163656/original/image-20170403-21976-1h63xjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=567&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163656/original/image-20170403-21976-1h63xjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=567&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163656/original/image-20170403-21976-1h63xjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=567&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Officials in southwest France ordered the slaughter of more than 600,000 ducks in February 2017 after an outbreak of bird flu.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/Search?query=bird+flu&ss=10&st=kw&entitysearch=&toItem=15&orderBy=Newest&searchMediaType=excludecollections">Bob Edme/AP</a></span>
</figcaption>
</figure>
<p>While preventing pandemics is expensive, it’s infinitely cheaper than the costs of actual pandemics. A report by the World Bank found a bird flu pandemic comparable to those from the last century could trigger a major global recession, with a <a href="http://www.reuters.com/article/us-reutersmagazine-davos-flu-economy-idUSBRE90K0F820130121">fall in global GDP</a> between 0.7 percent and 4.8 percent. While that might not sound like much, it represents $833 billion to <a href="http://statisticstimes.com/economy/countries-by-projected-gdp.php">$5.7 trillion</a>.</p>
<p>Billions have already been spent on pandemics this century. As an epidemiologist who worked for one U.S. pandemic prevention initiative sponsored by USAID, I don’t question the amounts being spent. What I do question is the return on investment using current unproven strategies that do nothing to address the urgency of the situation right now.</p>
<h2>National security, science and public health</h2>
<p>Since the 1970s, when USAID recognized that improved population health was integral to development goals, the number of infectious disease outbreaks has <a href="http://rsif.royalsocietypublishing.org/content/11/101/20140950">tripled</a>. In response, USAID created the <a href="https://www.usaid.gov/news-information/fact-sheets/emerging-pandemic-threats-program">Emerging Pandemic Threats program</a>, which focuses on discovering new animal viruses that may pose threats to human health.</p>
<p>However, it’s a big jump to identifying an animal virus with pathogenic potential to one that actually “spills over” and infects human populations. Instead of being an applied public health program with immediate potential to prevent pandemics, virus discovery is traditional scientific research. This research also does not address other pathogens that already pose pandemic threat, such as Zika, which is mosquito-borne, or superbugs (i.e., multidrug resistant bacteria). It turns out that the real problem to preventing pandemics is people.</p>
<p>Limited knowledge of human practices that increase risk of infection and of the diseases that pose the greatest risk represent the fundamental challenges to prevention. In 2015, the World Health Organization developed a list of emerging diseases likely to cause <a href="http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/">severe outbreaks</a> in the near future: Crimean Congo hemorrhagic fever, Ebola virus disease and Marburg, Lassa fever, MERS and SARS coronavirus diseases, Nipah and Rift Valley fever. Three “serious” backup diseases didn’t make the final cut: chikungunya, severe fever with thrombocytopaenia syndrome and Zika (avian flu is treated separately). As history has shown us with Zika, we have a pretty good sense of what we’re up against in terms of disease. </p>
<h2>Is there a better way to prevent pandemics?</h2>
<p>Tools exist to determine which high-risk diseases are already circulating in human populations. Ebola provides a useful example. Decades before an outbreak was reported, a study found that Liberians <a href="http://www.who.int/bulletin/volumes/95/1/16-175984.pdf">had been exposed to Ebola</a> – and survived. </p>
<p>Although there are few studies like this, Liberia is not a unique example. Scientists in Gabon documented Ebola exposure years prior to its first reported outbreak. Disease exposure may predict countries at highest risk for future outbreaks, but provides no information about how people are infected.</p>
<p>That has changed. New tools exist which measure both the diseases that are circulating and the <a href="http://www.who.int/bulletin/volumes/95/1/16-175984.pdf">behaviors</a> that put people at risk of catching them. In fact, this approach, which integrates biological and behavioral surveillance, is already familiar to other successful USAID programs. </p>
<p>The closer we come to identifying where an outbreak will occur and which disease will be the likely culprit, the faster we can prioritize areas of highest risk. Targeted prevention strategies include developing diagnostics and vaccines in enough quantity to inoculate the population at immediate risk. </p>
<p>Since outbreaks often happen in remote areas with limited health infrastructure, the ability to vaccinate and detect disease will involve health systems strengthening – again beginning with regions at highest risk of known outbreak potential. </p>
<p>On March 3, the government stated increased concern regarding <a href="http://www.nbcnews.com/health/health-news/cdc-concerned-h7n9-bird-flu-s-sudden-spread-china-n728946">upgraded</a> H7N9 bird flu. Even if this is not the next pandemic, there is always another threat waiting in the wings. We have the tools to provide a formidable, cost-effective first pass at pandemic prevention. It’s time to get the most bang for the buck we still have left – and to protect our national security on all fronts.</p><img src="https://counter.theconversation.com/content/75281/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maureen Miller does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An active outbreak of a type of bird flu in China raises concerns about worldwide pandemics. Ebola and Zika viruses still threaten. Here’s why this is not the time to cut funding.Maureen Miller, Adjunct Associate Professor of Epidemiology, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.